Provider Demographics
NPI:1972758415
Name:THOMAS, MEKIA (LMT)
Entity type:Individual
Prefix:
First Name:MEKIA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310761
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-0761
Mailing Address - Country:US
Mailing Address - Phone:678-367-9621
Mailing Address - Fax:404-477-0906
Practice Address - Street 1:785 VIRGINIA AVE STE B
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1991
Practice Address - Country:US
Practice Address - Phone:678-367-9621
Practice Address - Fax:404-477-0906
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist